大转子区筋膜骨膜血管分布及其临床意义

Vascular distribution of the fascia and periosteum of the greater trochanter

目的：为股方肌蒂大转子筋膜骨膜骨瓣移位术提供解剖学基础。方法：在３４侧下肢标本上对大转子区筋膜和骨膜的形态特点及其血供进行了解剖学观察。结果：大转子区筋膜较厚，分浅、深两层，与臀大肌筋膜和大转子骨膜通过疏松结缔组织相连。筋膜和骨膜的动脉来源为多源性，来自旋股内侧动脉深支、臀下动脉大转子支、第１穿动脉升支、旋股外侧动脉升支和横支。它们在大转子形成广泛的吻合。旋股内侧动脉深支管径为１．７±０．５ｍｍ，长３．３±０．７ｃｍ，其筋膜支和骨膜支是大转子的主要营养血管。臀下动脉大转子支管径１．４±０．５ｍｍ，长５．２±０．８ｃｍ，常与旋股内侧动脉深支吻合。结论：带筋膜血管的骨膜骨瓣比不带筋膜的骨膜骨瓣血供丰富。根据大转子区筋膜和骨膜的血管分布特点，可设计带筋膜血管的股方肌蒂大转子骨膜骨瓣。

Objective: To provide anatomy basis for the greater trochanter fascioperiosteal bone flap pedicled with the femoral quadratus muscle.Methods: The morphological characteristics and blood supply of the fascia and periosteum on the greater trochanter were studied on 34 lower limbs cadavers.Results:The fascia was thick and consisted of superficial and deep layers.It connected with the fascia of maximum gluteal muscle and the periosteum of greater trochanter through loose connective tissue.Its blood supply originated from the profound branch of medial circumflex femoral artery, the greater trochanter branch of inferior gluteal artery, the ascending branch of the lst perforating artery.These arterial branches anastomosed extensively on the greater trochanter.The external diameter and length of the profound branch of the medial circumflex femoral artery averaged 1.7±0.5 mm and 3.3±0.7 cm. The fascial and periosteal branches were the major nourishment artery to the greater trochanter.The greater trochanter branch of the inferior gluteal artery often anastomosis with the profound branch of the medial circumflex artery, its external diameter and the length was 1.5 ± 0.5 mm and 5.2±0.8 cm.Conclusions:The blood supply of the periosteal bone flap with fascial vessels was richer than that of no fascial vessels.A greater trochanter fascioperiosteal bone flap pedicled with the femoral quadratus muscle could be designed.